不需植骨融合治疗生长中儿童脊柱侧弯的新装置

A new instrumentation without fusion for the treatment of progressive idiopathic scoliosis in growing children

目的 为了避免需多次手术延伸内固定的缺点 ,研究自行设计的脊柱侧弯矫正装置板棍系统 (PRSS)治疗机制及其治疗生长中儿童特发性脊柱侧弯的疗效。方法 用PRSS矫治 34例逐渐加重的生长中儿童特发性脊柱侧弯 ,通过生物力学测试及动物模型X型胶原测试分析PRSS的矫治机制。结果 侧弯术前平均 6 3 6 3°± 19 80°(4 0°～ 110°) ,术后平均 2 3 91°± 15 6 3°(6°～ 6 6°) ,平均矫正率 6 4 0 6 %± 17 0 2 % ,最好者为 87 2 7%。随诊 2 8例 ,平均随诊 2 9 6个月 ,有 15例平均矫正丢失 8°,其余病例无丢失。手术矫正部位脊柱继续生长 ,平均13 5mm ,无严重并发症。放置PRSS后 ,在脊柱侧弯凸侧产生压应力 ,在凹侧产生张应力 ,而不需要植骨。动物试验X型胶原测试证实 :在压应力增力侧的椎体终板软骨退变加速 ,从而抑制该侧生长 ,而张力侧则不受影响 ,两侧不平衡生长达到脊柱变直的目的。结论 PRSS矫正装置能随脊柱生长自动延伸 ,在治疗脊柱侧弯时不需植骨融合 ,通过一次手术即能满意矫正生长中儿童的脊柱侧弯 ,并在生长过程中维持其矫正 ,具有特殊的生物力学矫正能力。

Objective To avoid the repeated operative lengthening and study the therapeutic mechanism of an innovated instrumentation Plate-Rod System for scoliosis (PRSS) and its effectiveness for the surgical management of idiopathic scoliosis in growing children. Methods 34 young children with progressive idiopathic scoliosis were treated using PRSS without fusion. Biomechanical test and type X collagen was made to express it's therapeutic biomechanism. Results The preoperative scoliotic curve was 63.63°±19.80° on average (40°～110°) and postoperative curve was 23.91°±15.63° with mean percentage of correction was 64.06%±17.02%, the best being 87.27%. The average loss of correction of 8° was found in 15 cases at the time of average 29.6 months follow-up. The remaining cases have no loss of correction. An average of 13.5 mm spinal lengthening of the instrumental segments was achieved. With PRSS put in place, compressive stress was formed on the convex side, while tensile stress on the concave side of the curvature, and more type X collagen mRNA to be expressed on convex side than concave side. This suggested that compressive stress led to increase earlier cartilage degeneration of the end plate on convex side so as to retard the growth of the end plate of this side, resulting in maximum spinal realignment. No severe complication was found in our series. Conclusion The PRSS, which dispenses with spinal fusion, can provide and maintain desirable correction of scoliosis in one stage operation, and will extend itself to keep up with the growth of the spinal column, which is helpful to prevent truncal shortening and 'crankshaft phenomenon'. This device is a new effective instrumentation for correcting scoliosis, especially in case of growing children.